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Perforator flap reconstruction
Abstracts radio-opacity was analysed in the postoperative phase. The appliances were comfortable to be maintained for longer consolidation periods. Conclusions: Distraction osteogenesis is indicated in severe deformities for two-dimensional or three-dimensional corrections, avoiding bone grafting and long hospital stays reducing costs and morbidity. http://dx.doi.org/10.1016/j.ijom.2017.02.081 Perforator flap reconstruction A. Gulati Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom Free flap reconstruction is the established gold standard for reconstruction of defects following oral and head and neck cancer ablation. Donor site morbidity is a concern in some cases and more recently perforator flaps have become increasingly popular. Preoperative workup involves mapping out the surface vessels over the donor skin using a hand-held Doppler probe which helps identify the location of the perforator(s) intraoperatively. Once identified, perforator dissection is performed back to the parent pedicle or until adequate vessel length is obtained to facilitate microvascular anastomosis. The advantages of these flaps are minimal donor site morbidity and provide more flexibility to reconstruction options. Some examples are anterolateral thigh perforator, anteromedial thigh perforator flaps, thoracodorsal artery perforator and medial sural artery perforator flaps amongst others. Freestyle perforator flaps have also been described where the perforator vessel dissected may not be a known named vessel, and adds a further dimension. Reconstruction of complex head and neck defects pose a challenge and chimeric flaps have an important role in these cases. Chimeric flaps allow different combinations of skin/muscle/bone paddles to be dissected onto one parent pedicle thereby reducing the number of microvascular anastomoses required. This technique is proving to be invaluable for reconstruction of complex defects whilst reducing both operating time as well as donor site morbidity.
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Treatment of temporomandibular joint ankylosis with severe mandibular deficiency by Biomet temporomandibular joint prosthesis D. He ∗ , Y. Hu Shanghai 9th People’s Hospital, China Background: Temporomandibular joint (TMJ) ankylosis is a refractory disease that is easy to recurrent. Objectives: This study aimed to evaluate the effects of TMJ prostheses in the treatment of TMJ ankylosis in patients with severe mandibular deficiency. Methods: Patients treated from 2013 to 2015 were reviewed. The computer-aided design/computer-aided manufacturing technique was used to guide bony mass removal and locate the TMJ prosthesis (Biomet, USA). Their facial profile, mouth opening and the results of computed tomography examination were evaluated. Findings: 11 patients with 15 joints were included. In four patients with severe mandibular deficiencies, their mandibular ramus was elongated by TMJ prostheses combined with Le Fort I osteotomy guided by digital templates. Their mean chin advancement was 10.19 mm. Their SNB and ramus heights were also significantly improved after operation (P < 0.05). All prostheses were successfully installed and stabilised intraoperatively. There was no prosthesis loosening, breakage, or infection leading to removal. No ectopic bone formations were found around the artificial condyles, and no bone resorption was detected around the screws after a mean follow-up period of 21 months (8–31 months). Mouth opening was significantly improved from 5.5 mm preoperatively to 31.6 mm postoperatively. Conclusion: TMJ prosthesis is a reliable treatment method for ankylosis, especially recurrent ankylosis. It can correct jaw bone deformities simultaneously with stable results. http://dx.doi.org/10.1016/j.ijom.2017.02.084 From traditional to perforated flaps in oral and maxillofacial surgery and head and neck reconstruction: principle, indication, imaging and clinical applications Y. He
http://dx.doi.org/10.1016/j.ijom.2017.02.082
Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
Precise management of the lesions in the skull base under the guidance of computer-aided navigation
Free flaps transfer for oral maxillofacial and head neck reconstruction should not only eliminate the dead space, but also provide satisfactory contours and restore the original oral functions. In the past 30–40 years, conventional free flaps such as radial forearm flap, pectoralis major myocutaneous flaps, latissimus dorsi flaps, fibula flaps, etc., acted as horse work flaps in great efforts at reconstruction of soft and hard tissues. Over the past decades perforator flaps have gained the interest of the reconstructive surgeons as an ideal option for tissue transfer without sacrificing main artery and muscle in the donor site. The purpose of this study is to report on the principle, indication, imaging and clinical applications of ideal perforator flaps. We used colour Doppler ultrasound, computed tomography angiography and magnetic resonance angiography techniques for accurately locating the perforators preoperatively. A series of perforator flaps, such as the medial sural artery perforators flap, superficial iliac circumflex perforators flap, deep inferior epigastric artery, internal mammary artery perforator, thoracoacromial artery perforator, deep circumflex iliac artery perforator and buccal artery perforators flap were performed on patients with different
C. Guo ∗ , X. Liu, Y. Zhang, Z. Cai, Y. Guo, G. Yu Peking University School of Stomatology, Beijing, China Computer-aided navigation is a kind of special instruments, which are connected to the navigation system to touch an anatomical position on the patient. This position is simultaneously shown in the images taken from this patient. The surgeon can thus use the instrument to ‘navigate’ the images of the patient by moving the instrument. We used this technique to handle the lesion under the skull base, including orbit reconstruction, resection of skull base tumours, treatment of temporomandibular joint ankylosis, removal of foreign bodies, needle biopsy, placement of radiation seeds, etc. Our experience shows that navigation technique can provide precise preoperative surgical design and navigate surgical procedures according to the design, improving surgical accuracy and raising safety. http://dx.doi.org/10.1016/j.ijom.2017.02.083
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Treatment of temporomandibular joint ankylosis with severe mandibular deficiency by Biomet temporomandibular joint prosthesis D. He ∗ , Y. Hu Shanghai 9th People’s Hospital, China Background: Temporomandibular joint (TMJ) ankylosis is a refractory disease that is easy to recurrent. Objectives: This study aimed to evaluate the effects of TMJ prostheses in the treatment of TMJ ankylosis in patients with severe mandibular deficiency. Methods: Patients treated from 2013 to 2015 were reviewed. The computer-aided design/computer-aided manufacturing technique was used to guide bony mass removal and locate the TMJ prosthesis (Biomet, USA). Their facial profile, mouth opening and the results of computed tomography examination were evaluated. Findings: 11 patients with 15 joints were included. In four patients with severe mandibular deficiencies, their mandibular ramus was elongated by TMJ prostheses combined with Le Fort I osteotomy guided by digital templates. Their mean chin advancement was 10.19 mm. Their SNB and ramus heights were also significantly improved after operation (P < 0.05). All prostheses were successfully installed and stabilised intraoperatively. There was no prosthesis loosening, breakage, or infection leading to removal. No ectopic bone formations were found around the artificial condyles, and no bone resorption was detected around the screws after a mean follow-up period of 21 months (8–31 months). Mouth opening was significantly improved from 5.5 mm preoperatively to 31.6 mm postoperatively. Conclusion: TMJ prosthesis is a reliable treatment method for ankylosis, especially recurrent ankylosis. It can correct jaw bone deformities simultaneously with stable results. http://dx.doi.org/10.1016/j.ijom.2017.02.084 From traditional to perforated flaps in oral and maxillofacial surgery and head and neck reconstruction: principle, indication, imaging and clinical applications Y. He
http://dx.doi.org/10.1016/j.ijom.2017.02.082
Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
Precise management of the lesions in the skull base under the guidance of computer-aided navigation
Free flaps transfer for oral maxillofacial and head neck reconstruction should not only eliminate the dead space, but also provide satisfactory contours and restore the original oral functions. In the past 30–40 years, conventional free flaps such as radial forearm flap, pectoralis major myocutaneous flaps, latissimus dorsi flaps, fibula flaps, etc., acted as horse work flaps in great efforts at reconstruction of soft and hard tissues. Over the past decades perforator flaps have gained the interest of the reconstructive surgeons as an ideal option for tissue transfer without sacrificing main artery and muscle in the donor site. The purpose of this study is to report on the principle, indication, imaging and clinical applications of ideal perforator flaps. We used colour Doppler ultrasound, computed tomography angiography and magnetic resonance angiography techniques for accurately locating the perforators preoperatively. A series of perforator flaps, such as the medial sural artery perforators flap, superficial iliac circumflex perforators flap, deep inferior epigastric artery, internal mammary artery perforator, thoracoacromial artery perforator, deep circumflex iliac artery perforator and buccal artery perforators flap were performed on patients with different
C. Guo ∗ , X. Liu, Y. Zhang, Z. Cai, Y. Guo, G. Yu Peking University School of Stomatology, Beijing, China Computer-aided navigation is a kind of special instruments, which are connected to the navigation system to touch an anatomical position on the patient. This position is simultaneously shown in the images taken from this patient. The surgeon can thus use the instrument to ‘navigate’ the images of the patient by moving the instrument. We used this technique to handle the lesion under the skull base, including orbit reconstruction, resection of skull base tumours, treatment of temporomandibular joint ankylosis, removal of foreign bodies, needle biopsy, placement of radiation seeds, etc. Our experience shows that navigation technique can provide precise preoperative surgical design and navigate surgical procedures according to the design, improving surgical accuracy and raising safety. http://dx.doi.org/10.1016/j.ijom.2017.02.083